Optimizing Pediatric Subspecialty Care Through Telemedicine and e-Consultations

通过远程医疗和电子咨询优化儿科亚专科护理

• 批准号: 9313025
• 负责人: Kristin N Ray
• 金额: $ 15.6万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9313025
• 关键词: Address; Age; Applications Grants; Attitude; Belief; Caring; Child; Child Care; Child health care; Childhood; Chronic; Chronic Disease; Clinic; Clinical Informatics; Communication; Complex; Consultations; Data; Data Set; Databases; Decision Making; Diffusion; Ensure; Ethnic Origin; Face; Future; General Practitioners; Geography; Goals; Health; Health Services; Health Services Accessibility; Healthcare; Home environment; Improve Access; Intervention; Lead; Medicaid; Medical center; Mentors; Mentorship; Methods; Mission; National Institute of Child Health and Human Development; Outcome; Parents; Patient Care; Patients; Pattern; Pennsylvania; Persons; Physicians; Population; Primary Health Care; Quality of Care; Race; Randomized Controlled Trials; Research; Research Personnel; Resources; Role; Rural; Site; Statistical Models; Surveys; System; Technology; Telemedicine; Time; Training; Underinsured; Underserved Population; United States; Visit; Visual; Vulnerable Populations; Work; base; beneficiary; care delivery; care systems; career development; cost; didactic education; disparity reduction; education research; experience; health care delivery; health disparity; implementation science; improved; improved outcome; individual patient; innovation; insight; minority children; new technology; novel; novel strategies; patient oriented; skills; socioeconomic disparity; socioeconomics; therapy design; tool

Over one quarter of children in the United States live with chronic health conditions. Many of these children require care from pediatric subspecialist physicians. However, 24% of children in need of subspecialty care have difficulty accessing this care due to geographic and socioeconomic barriers. Telemedicine is a novel approach for overcoming these barriers by delivering pediatric subspecialty across a distance using two-way audio-visual technology. Early data suggest that telemedicine has great potential to expand access and reduce disparities in pediatric subspecialty care. Yet much about telemedicine is poorly understood, with few studies examining how it is currently used or how to use it more effectively. Such data are important because uncritical expansion of telemedicine poses potential harms as well as potential benefits, including the potential for inappropriate use, unnecessary overuse, or exacerbated disparities if new technology is afforded to only a subset of the population. A critical need exists to identify current determinants of telemedicine use, barriers to use, and optimal strategies to ensure appropriate use by integrating subspecialty telemedicine into the patient- centered medical home. The overall goal of this study is to develop actionable strategies to advance the delivery of pediatric subspecialty care through telemedicine to overcome disparities and improve child health. In Aim 1, we will determine patient, subspecialist, primary care, and system-level factors associated with the use of telemedicine for ambulatory pediatric subspecialty care through analysis of a large, state-wide Medicaid database. In Aim 2, we will identify physician-perceived barriers to use of telemedicine for ambulatory pediatric subspecialty care through a national survey. In Aim 3, we will use data from prior aims along with clinician and parent input to develop a generalist-subspecialist e-consultation platform to improve appropriate use of telemedicine for ambulatory pediatric subspecialty care. Through these aims, we will significantly improve our understanding of the role of telemedicine in improving access to care for children with chronic conditions, setting the stage for future interventions to optimize outcomes through appropriate telemedicine use. With guidance from committed mentors and strong institutional support, the PI will also receive the necessary intensive mentorship, didactic education, and research experience to become an independent investigator, supporting career development objectives in advanced statistical modelling, implementation science, and clinical informatics. This work will provide essential preliminary data to support future grant applications to examine the impact of telemedicine use in observational data and to perform a pilot randomized controlled trial of the e-consultation platform developed herein. With these new skills and novel preliminary data, the PI will be poised to lead large studies to examine and improve the diffusion and impact of innovations in pediatric health care delivery, ultimately improving outcomes for children in need of subspecialty care and furthering NICHD’s mission of ensuring that all children achieve their full potential for healthy and productive lives.

美国有四分之一的儿童患有慢性健康状况。其中许多孩子 需要小儿专科医生的护理。但是，有24％需要专科护理的儿童 由于地理和社会经济障碍，很难获得此护理。远程医疗是一本小说 通过双向交付小儿专业的方法来克服这些障碍的方法 视听技术。早期数据表明，远程医疗具有扩展访问和减少的巨大潜力 小儿专科护理的差异。然而，关于远程医疗的很多知识是很少的，很少有研究 检查当前如何使用或如何更有效地使用它。这样的数据很重要，因为不批判性 远程医疗的扩展会构成潜在的危害和潜在的好处，包括潜在的潜力 如果仅提供新技术，则不当使用，不必要的过度使用或加剧分布 人口子集。存在着重要的需求，以确定远程医疗使用的当前决定者，障碍 使用和最佳策略，以确保适当使用，通过将亚科远程医疗集成到患者中 - 中心医疗之家。这项研究的总体目标是制定可行的策略，以推动 通过远程医疗提供小儿专科护理，以克服分布并改善儿童健康。 在AIM 1中，我们将确定与患者，专科医生，初级保健和系统级别的因素相关的患者 通过分析大型的，全州的医疗补助 数据库。在AIM 2中，我们将确定使用远程医疗用于门诊儿科的物理感知障碍 通过全国调查，子专业护理。在AIM 3中，我们将使用先前目标的数据以及临床和 父母的输入以开发通才苏格斯主义的电子咨询平台，以改善适当的使用 远程医疗用于门诊小儿专科护理。通过这些目标，我们将显着改善我们的 了解远程医疗在改善患有慢性疾病儿童的护理方面的作用， 为将来的干预措施设定阶段，以通过适当的远程医疗使用来优化结果。和 忠实导师和强大的机构支持的指导，PI还将获得必要的 深入的心态，教学教育和研究经验，成为独立研究者， 支持高级统计建模，实施科学和 临床信息。这项工作将提供基本的初步数据，以支持未来的赠款申请 检查远程医疗在观察数据中的影响并执行试验随机对照试验 在这里开发的电子咨询平台。有了这些新技能和新颖的初步数据，PI将是 准备领导大型研究来检查和改善创新对小儿健康的扩散和影响 护理交付，最终改善了需要亚专科护理的儿童的成果 确保所有儿童都能充分发挥健康和产品生活的可能性。